Purpose:To test the hypothesis that needlescopic cholecystectomies (NC) offer superior outcomes in comparison to common laparoscopic cholecystectomies (LC). Methods: Sixty consecutive patients with gallbladder disease undergoing either LC or NC were evaluated with respect to differences in operative time, frequency of per-operative incidents, post-operative pain, late postoperative symptoms, length of scars and level of postoperative satisfaction. Results: Mean operative time was similar in both groups. Most of the patients, irrespective of the technique, informed mild postoperative pain. NC patients had lower levels of pain on the 7 th postoperative day (PO7) (p<0.01) and decreased need for additional analgesia. Less frequency of epigastric wound pain was observed in NC patients until PO4 (p<0.01). Aesthetic result was far superior after NC (total length of scars less than half after LC). No differences regarding postoperative satisfaction with the operation were observed between the studied groups. Conclusions: Both techniques were safe and effective, presenting similar operative times and low levels of postoperative pain. Downsizing the ports to 2-3 mm was associated with significantly less frequency of postoperative pain only in the epigastric wound until PO4. Aesthetic outcome of NC was significantly superior to LC, although this advantage did not influence patient level of satisfaction Key words: Cholecystectomy, Laparoscopic. Pain Postoperative. RESUMOObjetivo: Testar a hipótese de que colecistectomias agulhascópicas oferecem resultados superiores aos da colecistectomia laparoscópica usual (CL). Métodos: Sessenta pacientes consecutivos com colecistopatia submetidos à CA ou CV foram avaliados quanto ao tempo operatório, freqüência de acidentes peroperatórios, dor pós-operatória, sintomas pós-operatórios tardios, comprimento das cicatrizes e grau de satisfação. Resultados: O tempo operatório médio foi semelhante em ambos os grupos. A maioria dos pacientes, independentemente da técnica, relataram dor pós-operatória leve. Aqueles operados por CA tiveram menores níveis de dor no 7º dia de pós-operatório (PO7) (p<0.01) e menor necessidade de analgesia adicional. Menor freqüência de dor epigástrica foi observada no grupo CA até o PO4 (p<0.01). O resultado estético foi amplamente superior após CA (comprimento total das cicatrizes menor que a metade após CL). Não houve diferença quanto ao grau de satisfação entre os grupos. Conclusões: As duas técnicas foram seguras e eficazes, apresentando tempos operatórios semelhantes e baixos níveis de dor pós-operatória. A redução dos portais para 2-3 mm associou-se a menor freqüência de dor pós-operatória apenas na incisão epigástrica até o PO4. O resultado estético da agulhascopia foi significantemente superior ao da laparoscopia, apesar desta vantagem não ter influenciado o grau de satisfação dos doentes. Descritores: Colecistectomia Laparoscópica. Dor Pós-Operatória.

BACKGROUND:Protein p16INK4a immunocytochemistry (ICCp16) has the potential to reveal lesions at risk of progression to anal cancer. This study examined measures of diagnostic validity of ICCp16 in HIV‐positive patients treated at the Tropical Medicine Foundation of Amazonas in the coloproctology outpatient clinic.METHODS:One hundred ninety HIV‐positive patients were consecutively enrolled in 2007 and 2008. All patients underwent anal cytologic sampling to perform ICCp16 in conventional and GluCyte (Synermed International, Westfield, Indiana and S¸ao Paulo, Brazil) smears and also for genotyping of human papillomavirus (HPV). Patients were then subjected to anal biopsies monitored by high‐resolution anoscopy. Hematoxylin‐eosin and immunoperoxidase p16 (clone 6H12) stains were performed in slides with biopsied and cytological specimens, respectively. HPV genotyping on anal scrapings was performed by a polymerase‐chain reaction (PCR)‐based method. The immunochemical findings were compared with histopathological and PCR results in contingency tables and analyzed by nonparametric tests. Measures of diagnostic validity of ICCp16 were calculated. Statistical significance was set at P ≤ .5.RESULTS:There was no statistically significant association between the immunochemical results (conventional or GluCyte smears) and histopathological or HPV genotyping findings (P > .05). In the best scenario, ICCp16 presented 31% sensitivity and 81% specificity for the diagnosis of anal squamous intraepithelial lesion (ASIL) and 30% and 66%, respectively, for the diagnosis of infection with high‐risk HPV.CONCLUSIONS:There was no association between ICCp16 results and histopathological findings nor between ICCp16 and HPV genotyping. ICCp16 showed poor sensitivity and moderate specificity for the diagnosis of ASIL or high‐risk HPV. Cancer (Cancer Cytopathol) 2011. © 2011 American Cancer Society.

Purpose: the purpose of this research was to identify the sociodemographic and microbiological characteristics and antibiotic resistance rates of patients with diabetic foot infections, hospitalized in an emergency reference center. Methods: it was an observational and transversal study. The sociodemographic data were collected by direct interview with the patients. During the surgical procedures, specimens of tissue of the infected foot lesions were biopsied to be cultured, and for bacterial resistance analysis. Results: the sample consisted of 105 patients. The majority of patierns were men, over 50 years of age, married and with low educational level. There was bacterial growth in 95 of the 105 tissue cultures. In each positive culture only one germ was isolated. There was a high prevalence of germs of the Enterobacteriaceae family (51,5%). Gram-negative germs were isolated in 60% of cultures and the most individually isolated germs were the Gram-positive cocci, Staphylococcus aureus (20%) and Enterococcus faecalis (17,9%). Regarding antibiotic resistance rates, a high frequency of Staphylococcus aureus resistant to methicillin (63,0%) and to ciprofloxacin (55,5%) was found; additionally, 43,5% of the Gram-negative isolated germs were resistant to ciprofloxacin. Conclusions: the majority of patients were men, over 50 years of age, married and with low educational level. The most prevalent isolated germs from the infected foot lesions were Gram-negative bacteria, resistant to ciprofloxacin, and the individually most isolated germ was the methicillin resistant Staphylococcus aureus.

RESUMO: O câncer anal representa aproximadamente 2% dos cânceres colorretais. Nos últimos anos observa-se o aumento da incidência nos indivíduos HIV positivos. Este estudo teve como objetivo avaliar a prevalência de lesões intra-epiteliais escamosas anais (ASIL) em pacientes HIV+ procedentes de Manaus. Foram estudados 45 doentes HIV+ encontrando-se no exame histopatológico, os seguintes resultados: 15(35,7%) lesões de baixo grau, 3(7,1%) lesões de alto grau e 24(57,2%) negativos para ASIL. Houve, portanto, alta prevalência de ASIL, 42,8%. Concluímos que a prevalência de ASIL entre os pacientes HIV positivos, da amostra estudada, é muito importante, justificando-se a implantação de um programa de acompanhamento e detecção precoce, destas lesões; pois os pacientes HIV+ representam um importante grupo de risco para o desenvolvimento do câncer anal.

Purpose:To investigate the prevalence of anal squamous intraepithelial lesions (ASIL) or anal cancer in patients attended at the Tropical Medicine Foundation of Amazonas. Methods: 344 patients consecutively attended at the institution, in 2007/2008, were distributed in the following strata according to presence/abscense of at risk conditions for anal cancer: Group 1 -HIV-positive men-who-have-sex-with-men (101); Group 2 -HIV-positive females (49); Group 3 -patients without any at risk condition for anal cancer (53); Group 4 -HIV-positive heterosexual men (38); Group 5 -HIV-negative patients, without anoreceptive sexual habits, but with other at risk conditions for anal cancer (45); Group 6 -HIV-negative men-who-have-sex-with-men (26); and Group 7 -HIVnegative anoreceptive females (32). The histopathological results of biopsies guided by high-resolution anoscopy were analyzed by frequentist and bayesian statistics in order to calculate the point-prevalence of ASIL/cancer and observe any eventual preponderance of one group over the other. Results: The point-prevalence of ASIL for all the patients studied was 93/344 (27%), the difference between HIV-positive and negative patients being statistically significant (38.3% versus 13.5%; p < 0.0001). The prevalence of ASIL for each one of the groups studied was: Group 1 = 49.5%, Group 2 = 28.6%, Group 3 = 3.8%, Group 4 = 21.1%, Group 5 = 11.1%, Group 6 = 30.8% and Group 7 = 18.8%. Standard residual analysis demonstrated that ASIL was significantly prevalent in patients of Group 1 and high-grade ASIL in patients of Group 2. The odds for ASIL of Group 1 was significantly higher in comparison to Groups 2, 3, 4, 5 and 7 (p < 0.03). The odds for ASIL of Groups 2, 4 and 6 were significantly higher in comparison to Group 3 (p < 0.03). Conclusions: In the patients studied, ASIL (low and/or high-grade) tended to be significantly more prevalent in HIV-positive patients. Nonetheless, HIV-negative anoreceptive patients also presented great probability to have anal cancer precursor lesions, mainly those of the male gender. Key words: Anal Canal. Anus Neoplasms. Epidemiology. HIV. Anal cancer precursor lesions in HIV-positive and HIV-negative patients seen at a tertiary health institution in BrazilActa Cirúrgica Brasileira -Vol. 26 (1) (101); Grupo 2 -mulheres HIV-positivas (49); Grupo 3 -pacientes sem condição de risco para o câncer anal (53); Grupo 4 -homens heterossexuais HIV-positivos (38); Grupo 5 -pacientes HIV-negativos, sem hábitos sexuais anorreceptivos, mas com outras condições de risco para o câncer anal (45); Grupo 6 -homens-que-fazem-sexo-com-homens HIV-negativos (26); e Grupo 7 -mulheres HIV-negativas, com hábitos sexuais anorreceptivos (32). Os resultados histopatológicos das biópsias anais dirigidas pela colposcopia anal foram analisados por meio de estatística frequentista e bayesiana para a determinação da prevalência-ponto de ASIL/câncer e verificar eventual preponderância estatística de um grupo sobre o outro. Resultados: A prevalência-ponto de ASIL para t...

With a prevalence of 23.81% of subclinical ASIL-ACU lesions, the studied renal graft recipients had all these lesions detected by high-resolution anoscopy, notwithstanding most anal transition zone acetowhitened biopsied areas did not reveal histopathological aspects of anal cancer precursor lesions or condyloma acuminatum. Therefore, greater experience with the diagnostic tool was felt necessary to enhance its positive predictive value, specificity and diagnostic precision.

INTRODUÇÃOOs apêndices epiplóicos são pequenas saculações pedunculadas de peritônio repletas de tecido adiposo, de formato variável, medindo de 0,5 a 5 cm de comprimento, situadas em duas fileiras marginais ao longo do cólon, predominando no sigmóide e no ceco e poupando o reto. São individualmente supridos por uma ou duas artérias e drenados por uma delgada e tortuosa veia. Tais características anatômicas e sua excessiva mobilidade fazem dos apêndices epiplóicos estruturas propensas à torção, com conseqüente isquemia, quadro descrito como apendicite epiplóica (AE) 1 . RELATO DO CASOPaciente do sexo feminino, 42 anos, procurou o Hospital de Aeronáutica de Manaus queixando-se de dor no quadrante inferior direito (QID) do abdome de início abrupto há 24 horas, sem outros comemorativos. Ao exame físico, apresentava dor à palpação profunda no QID sem sinais de irritação peritoneal. O exame ginecológico revelou aumento da dor abdominal à mobilização uterina. Exames: hemogramaleucocitose de 12.000 cél./mm 3 ; urinálise -normal; Rx simples do abdome -normal; ultra-sonografia do abdome total -íleo segmentar na pelve.Com hipótese diagnóstica de abdome agudo inflamatório, a paciente foi encaminhada para investigação invasiva por meio de videolaparoscopia diagnóstica. As Figuras 1 e 2 demonstram o achado operatório de uma AE sigmóidea, cujo apêndice epiplóico estava bloqueado pelo mesossigmóide. Desfeito o bloqueio, o apêndice epiplóico foi excisado cirurgicamente e removido da cavidade abdominal por meio de técnicas videolaparoscópicas. A paciente recebeu alta hospitalar dois dias após, assintomática. DISCUSSÃOA AE acomete mais freqüentemente pessoas de meia idade de ambos os sexos, obesas ou que perderam peso recentemente, e faz parte do diagnóstico diferencial de apendicite aguda, diverticulite e dor pélvica crônica 1 . A dor é seu principal sintoma, localizando-se em ambos os quadrantes inferiores do abdome, mais comumente à direita. Costuma ser referida como imprecisa, em pontada ou em cólica e se acompanha de náuseas, vômitos, com ou sem febre. A duração dos sintomas é usualmente menor que uma semana. Exceto diante de complicações, os pacientes costumam estar bem clinicamente. A palpação abdominal normalmente revela defesa sobre a área acometida, sem sinais de irritação peritoneal. Pode haver uma leucocitose discreta 2 . Em condições normais os apêndices epiplóicos não são vistos por nenhum método de imagem, a menos que haja um volume suficiente de líquido peritoneal a oferecer con-

Our results showed that cotton swabs were as efficient as dacron swabs or cytologic brushes in the ability to produce satisfactory analpap readings.